Do Physicians and Administrators See Eye to Eye?

by John Gramer
Posted on May 25, 2016
As Featured in Accountable Care News

The answer is yes, according to the 2016 Cejka Search Healthcare Perspectives study of 1,621 practicing physicians and healthcare administrators. In the study, respondents were asked to rank the importance of ten healthcare delivery priorities. The results showed close alignment among physicians and administrators on both the highest and lowest priorities for care delivery in a post-reform environment. For example, both physicians and administrators rated effective patient communication as the highest priority issue and working with health plans the lowest.

Patient Experience: A Common Theme

Patient communication and collaboration with other providers rose to the top of the priority lists for both groups, indicating strong support for a team-based approach to care with the patient as the focus.

“Effective patient communication” was ranked the number one priority for both, defined in the survey as “explaining medical information, such as care plans, medications and patient responsibilities, in a way that patients understand and improves patient compliance.” In addition, both groups ranked “collaboration  with advanced practitioners and other providers” as part of the top three priorities.

The only difference in the top three rankings is “being viewed as a partner in patients’ long-term well-being,” priority number three among physicians, and “customer service orientation” ranked number two among administrators.

Even where rankings differed, there was a common theme -- the patient experience. Physicians were focused on collaborating with patients to achieve long-term wellness versus episodic care, while managers appeared to take the broader view of overall patient satisfaction.

Business Acumen Traits Revealed as Lowest Priorities

While all ten traits were ranked as high priorities by at least half of respondents, when force-ranked, business acumen traits fell to the bottom of the list for both groups. These included: “working knowledge of health insurance requirements,” “the ability to negotiate and influence health plans to cover procedures believed to be in the best interest of the patient,” and the “use of technology to practice medicine more efficiently.”

The fact that these are recognized as priorities for healthcare delivery but fall outside of the most important behaviors for physicians, underscores the need for broad collaboration across functions -- not just intra-care team collaboration but also collaboration between clinical and business operations, such as finance, technology, care utilization, and case management.

Opportunities for Greater Alignment

The study also uncovered opportunities for greater alignment among the two groups related to the definition of quality metrics and patient satisfaction goals.

The Need for a More Meaningful Definition of Quality

While there is significant support among physicians for a value versus volume approach, physicians expressed the need for more meaningful definition and measurements of quality. For example, one physician stated, “Most are still quantity-based metrics disguised as value,” referring to facility outcome goals. Another physician explained, “We risk quality when we focus on desired outcomes that are not founded on medical evidence.”

As a result, there was a 20-point difference in how important administrators and physicians viewed “achieving quality metrics set by your facility.”

Achieving Quality Metrics Set by Your Facility

Patient Satisfaction Goals at Odds with Evidence-Based Medicine

The Cost of Satisfaction Study conducted by Joshua J. Fenton, MD, MPH, in 2012, established a correlation between higher patient satisfaction scores and increased utilization of healthcare services. Healthcare experts credited the link to clinicians’ increasing desire to accede to requested treatments to please public and private payers, which had increasingly tied their reimbursements to patient satisfaction.

At present, with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores publicly reported and impacting one to one-and-a-half percent of a provider’s revenues, survey respondents indicated that patient satisfaction goals, evidence-based medicine and reimbursement incentives may be at odds.

Physicians stated:

“The notion that patient satisfaction equals good patient care is flawed.”

“Trying to please patients can actually lead to additional costs and run counter to quality care.”

Meanwhile, the shift towards evidence-based, standardized care as a way to improve overall clinical outcomes while lowering costs emphasizes prudent use of services and placing patients in appropriate care settings. Both of which may be counter to the wishes of the patient and/or family members

Mutual Understanding of Roles

With physicians and administrators bearing much of the weight of the industry’s transformation, it is not surprising that some respondents expressed frustration in the way they believe their roles are being perceived.

Of interest are the common themes expressed among both groups – both feel as though they are being held accountable for things they cannot control; both desire to be treated as more of a partner; and both feel the value of their roles are somewhat underappreciated.

Creating a Culture of Collaboration

Some of the advice offered by physicians and administrators for fostering greater collaboration between the two groups includes:

1. Nurture dyad leadership by coupling clinical experts with experts in workflow engineering, information technology, metrics management and financial reporting, to accelerate transformation and innovation.

2. Provide clinically-oriented training for more administrators so they can better understand the day-to-day demands of direct patient care.

3. Provide physicians with individual performance metrics, relative to facility and national peer groups, in order to empower them to more actively contribute to organizational goals.

4. Create cross-functional teams and committees to tackle transformational initiatives, including administrators, department managers, physicians, nurses, case managers, therapists, technicians and other staff members, for improved processes and employee engagement.

5. Involve clinicians in setting the agenda and key performance indicators for new care models, such as quality outcomes, value-based incentives, evidence based medicine practices, and clinical technology requirements. Rely on these clinical ambassadors to communicate the goals and rationale behind these initiatives with peers for improved physician engagement.

There is immense potential for physician contribution to creating solutions for today’s healthcare challenges. One doctor stated, “We understand delivery of care better than anyone and can be valuable resources in cutting waste and improving processes, if we are embraced as active participants in solving these problems.

Forward-thinking administrators also recognize the potential in harnessing the strength of various healthcare resources. As one chief executive officer commented in the survey, “The best administrators I know value and engage their physicians in creating facility standards and policy.”

John Gramer is president of Cejka Search, a nationally recognized physician, allied health and healthcare executive search firm specializing in healthcare for more than 30 years.